An OA phenotype may obtain major benefit from bone-acting agents

Area of Science:

• Rheumatology and Orthopedics
• Bone Biology and Disease
• Osteoarthritis Pathogenesis

Background:

• Osteoarthritis (OA) is characterized by subchondral bone microstructure alterations and increased remodeling, playing a key role in pathogenesis.
• Treatment of knee OA with antiresorptive drugs has yielded inconsistent results, indicating a potential subset of patients who respond well to reduced subchondral remodeling.

Purpose of the Study:

• To identify a specific osteoarthritis (OA) phenotype that may experience significant benefits from bone-acting therapies.
• To guide the development of targeted therapeutic strategies for distinct OA patient groups.

Main Methods:

• A systematic literature review was conducted using Medline and PubMed databases (1990-2013).
• Keywords included 'subchondral bone,' 'articular cartilage,' 'osteoarthritis,' 'bone agents,' 'bone mineral density,' and 'scintigraphy.'

Main Results:

• Early studies support the use of bone agents for OA cartilage damage; some agents show benefits in low back pain and spondylosis.
• Strontium ranelate demonstrated structural and clinical benefits in knee OA patients with radiological progression.
• Divergent results with other antiresorptives highlight the need for well-defined OA phenotypes and precise patient recruitment/monitoring methodologies.

Conclusions:

• A specific subset of postmenopausal patients with high subchondral bone remodeling and/or low bone density may benefit from bone-acting agents to slow OA progression.
• This distinct OA population can potentially be identified using a combination of subchondral bone dual-energy X-ray absorptiometry and scintigraphy.